Panmati Devi was brought to Nepal Cleft and Burn Centre in Kirtipur for the treatment of burn injuries from Bara district some two weeks ago. The 60-year-old woman, a local of Chainpur in Parwanipur Rural Municipality, was first taken to Narayani Hospital in Birgunj before she was referred to Kathmandu.

Doctors at the burn centre, usually known as Kirtipur Hospital, told her relatives that she had suffered 40 percent burns to her body and needed to undergo multiple surgeries.

"My mother got the burn injuries when she was warming herself in front of a straw bonfire,” said Sunil Kumar Patel, the son. “We are waiting for our turn for the surgery.”

Like Panmati Devi, dozens of fire victims from across the country are brought to the hospital for burn injuries, as most of the health centres, private as well as state-run, throughout the country lack proper treatment facilities for fire victims. As a result, the hospital is always crowded, and patients have to wait for days not only for surgery but also for beds.

The hospital had earlier allotted 30 beds for burn victims, but now with the surge in the number of patients, it is accommodating burn patients on beds of other wards.

"Over 60 fire victims are currently receiving treatment at our hospital," Dr Kiran Nakarmi, head of the Burns, Plastic and Reconstructive Surgery Department at the hospital, told the Post. "We have been extending an additional 16 beds for fire victims."

The number of patients with burn injuries rises during the winter, as people make bonfires to keep them warm. Elderly women and under-aged children are more vulnerable to fire incidents, as they remain in the house or near fires most of the time. “Their weak immune system compared to adults makes the recovery process even more complicated,” said Nakarmi.

Burns is the second most common injury in rural Nepal, accounting for 5 percent of disabilities, according to the World Health Organization.

Dr Peeyush Dahal, dean at the National Academy of Medical Sciences, told the Post last month that according to a study carried out in the past, 40,000 people suffer from burns [minor or severe] every year in Nepal.

The country, however, is miserably ill-equipped when it comes to treating burn patients.

Dr Shankar Man Rai, a plastic surgeon at the hospital, said patients who suffer more than 30 percent burns to their body need intensive care service, but the hospital has only eight beds in the intensive care unit.

"It is becoming increasingly difficult to save people with 40 percent burns to their bodies,” said Rai. "Many die due to infection and several other factors despite our efforts to save them.”

Kirtipur Hospital’s Nepal Cleft and Burn Centre is the largest burns ward in the country.

The country’s first dedicated burn ward was established at Bir Hospital around two decades ago. But after the 2015 earthquake, it was shifted to the National Trauma Centre, which provides treatment for burn injuries but lacks a dedicated intensive care unit for burn patients.

Burn injuries in Nepal are still not a health priority. The government has neither upgraded and increased facilities nor run any awareness programmes to deal with the situation in the immediate aftermath of burn.

According to Rai, most people do not know how to respond to burn injuries.

“People usually take patients to nearby health facilities which then refer them to other health centres,” said Rai. “Burn patients need enough intravenous fluids, around eight litres in 24 hours. This does not happen while transporting patients from one facility to another, which reduces their chances of survival.”

Doctors say lack of skin is another major problem in saving the lives of burn victims. Kirtipur Hospital had set up a skin bank in 2014. However, only 28 people have donated their skin posthumously to the bank.

Rai said people who suffer over 30 percent of burns need skin from others to cover the wounds and prevent infection.

"Substitute skin, available in developed countries, is too costly," said Rai. "We have not been able to convince people to donate skin. It’s just like donating eyes after death."

Doctors say awareness alone can substantially increase the chances of survival of burn patients.

“Many burn victims die due to ignorance or negligence," said Nakarmi.